Snyder, 72, of Huntington Beach found a less expensive plan for 2017 during an open enrollment event last week where a counselor entered her nine medications into a computer algorithm.

Her choice for president has been less clear.

"I just hate both of them," Snyder said from the Senior Center in Central Park. "Which is the best -- I'm not even sure of that."

Polls have shown health care to be a far less important issue than the economy and foreign policy in the race between Hillary Clinton and Donald Trump. But as early voting and Election Day coincide with open enrollment for Medicare, Obamacare and employer-sponsored insurance, some Southern Californians are weighing the future of the nation's health care system or their own out-of-pocket costs, as they cast their votes.

"Policy issues haven't exactly been front and center in this election," said Larry Levitt, a senior vice president at the Kaiser Family Foundation, a nonprofit health care research group in Menlo Park. "The outcome of the election would have big implications for the future of health care, but it hasn't emerged as a prominent issue in the campaign."

Levitt said one potential area of confusion for voters has been about rising premium costs for next year. He said most Americans are insured through their jobs, Medicare for seniors or Medicaid for low-income residents, which is called Medi-Cal in California.

He said non-Obamacare premiums are "going up generally pretty modestly."

"People are seeing these headlines about big increases in Obamacare premiums, and they think it affects them, but in most cases people aren't affected," Levitt said. "It's only a small sliver of the population that's covered through the Affordable Care Act marketplaces, which is where the premium increases are hitting. In employer plans, rates are going up at historically low rates."

Covered California rates will rise an average of 13.2 percent, more than three times the rate of previous increases the last two years. The jump is far lower than the average 22 percent increase for midlevel plans announced for the federal Obamacare exchange, which covers 39 states.

State officials have attributed the increase to factors such as the end of federal funds to stabilize premiums by helping cover high-cost claims; rising costs of specialty drugs; and some consumers signing up only after becoming sick.

"Covered California has done a great job of holding the line on prices," said Dr. J. Mario Molina, CEO of Long Beach-based Molina Healthcare, which offers plans in Los Angeles, Orange, San Bernardino and Riverside counties. "Covered California is an activist purchaser. They actually get in and negotiate with the plans, trying to keep costs down. Generally speaking, the rate of the increase in premiums overall is lower under the Affordable Care Act than it was before."

Hollie Young, 58, of Newport Beach was initially upset when she received a letter from Kaiser Permanente indicating that the Obamacare plan for her and her husband would increase to $630 a month from $523. The self-employed couple receive a subsidy of about $900 a month.

"At first we were upset about the $100 raise, and then we remembered before we were paying $1,650, so we're still saving $1,000 a month, so we should be happy," she said. "It was ridiculous. There were times we had to borrow money, take money out of our IRA; $1,650 a month is like a mortgage."

Young said she mailed her ballot for Clinton, noting the candidate's strong support for health reform since the days when her husband was president.

Snyder, who visited the nonprofit Health Insurance Counseling and Advocacy Program workshop for help choosing a Part D prescription plan, is struggling with paying for expensive medications because she's fallen into the coverage gap known as the doughnut hole. Three of her medications cost $1,000 for a three-month supply.

Snyder said she has worked to trim her budget, including cutting back on cable, has changed to a cheaper medication and comparison shops between pharmacies. She also signed up with one drugmaker's assistance program to receive a cholesterol medication at no cost.

The plan she selected for next year will keep her out of the gap, which is scheduled to be phased out in 2020 because of the Affordable Care Act. The option, offered through AARP, cuts her premium by more than half -- to $33.40 a month from $68.60.

Snyder, a registered Republican, said Monday that she ultimately decided to vote for Trump because overall she supports his policy views. He has called for a repeal of Obamacare, a program Snyder said she doesn't particularly like.

"It's about picking the best of two evils," she said.

Richard Chambers, senior vice president of policy and advocacy at Molina Healthcare, said debate over the Affordable Care Act is reminiscent of the reactions to the creation of Medicare and Medicaid in 1965.

"The program has survived Republican and Democratic administrations," Chambers said. "It's much different. It doesn't look like it did back in 1965. It went through a lot of changes and adaptation, and the parties agreed. It may not be any different for the ACA over the next 10 years but we don't know."

But not all with a stake in the Affordable Care Act will head to the polls.

On Tuesday morning, Gene Yancosky, 50, of Azusa signed up for an Obamacare plan through Covered California after paying a $700 penalty on his taxes last year for forgoing insurance. He chose a Health Net plan for $376 a month and did not qualify for a subsidy.

"That's perfect," he said of the price. "This is about what I used to pay through work. I think that's good, I just don't like the fine."

Yancosky, who works in construction but said his employer's insurance has too high of a deductible, said he's not registered to vote. He said he doesn't feel educated enough on political issues but was pleasantly surprised by the ease of enrolling at Quote Selection Insurance Services in Huntington Beach.